Internal surface of anterolateral abdominal wall.

The lower part of the anterolateral abdominal wall between the umbilicus and
pubic consists of varies folds and fossa which is result of the fetal development of
the human. All these folds and fossa are covered with transversalis fascia, a
variable amount of extraperitoneal fat and parietal peritoneum.
There are five umbilical peritoneal folds, pass from the umbilical in the downwards
direction.
The median umbilical fold- it is an occluded uruchus. This fold extends from the
umbilical ringe to the apex of the urinary bladder and covers the median umbilical
ligament.
The edial umbilical folds formed by the occluded umbilical arteries, cover the
medial umbilical ligaments. They lie externally to the median fold.
The lateral umbilical folds cover the inferior epigastric vessels. They lie lateral to
the medial umbilical folds.
Fossa of the anterolateral abdominal wall are the openings in the fascia
transversalis.
Between the median and medial umbilical folds there are two supravesical fossa.
Both supravesical fossa are situated behind the pubis but it depends of urinal
bladder’s filling and empting.
Medial inguinal fossa are situated between medial and lateral umbilical folds.
They lie upper than supravesical fossa on the same line as an external inguinal
ringe, opposite it. They may be potential sites for direct inguinal hernias.
Lateral inguinal fossa situated externally to the lateral umbilical folds. Through
these fossa the testes migrate into the scrotum and the spermatic cords stay after in
mal. And in femme the teres uteri ligaments pass through it. It is a potential sites
for the most oblique (common) inguinal hernias.
Abdominal part of esophagus.
The abdominal part of the esophagus is very short (only about 2-3cm long). It
inters the abdomen through the esophageal hiatus opening of the diaphragm at the
level of Th10, just to the left of the median plane. Through this hiatus also path the
left and right vagus, the esophageal branches of the left gastric artery and the
accompanying vein. The esophagus enters the cardiac orifice of the stomach is
located to the left of the midline at the level of the 7 th left costal cartilage and the
Th11 vertebra.
In the abdominal part the esophagus is covered by the peritoneum only anteriorly
(retroperitoneal) and on the left side.
Stomach.
Stomach is a food blends and reservoir, forming the widest and most distensible
part of the digestive tube. Its chief function is enzymatic digestion.
The stomach lies obliquely in the upper and left part of the abdomen. The long axis
of the stomach is directed forwards, downwards and to the right. It is occupied the
epigastric and left hypochondriac regions.
The shape of the stomach is dynamic (changing in shape as it function) and highly
variable from person to person.
The stomach is divided into the four parts and two curvatures and two surfaces.
1. the cardiac is surrounded the cardial orifice, the opening of the esophagus
into the stomach.
2. fundus of the stomach is the upper convex which relates to the left dome of
the diaphragm and limited inferiorly by a horizontal line drawn at the level
at the cardiac orifice. Between the esophagus and the fundus is situated in
the cardial notch.
3. the wide part of the stomach is the pyloric antrum, leads into the pyloric
canal, its narrow part. The pylorus, the distal sphincteric region, is a
thickening of the circular layer of smooth muscle, which controls discharge
of the stomach contents through the pyloric orifice into the duodenum.
4. the body is the part of the stomach which lies between the fundus and the
pyloric antrum.
5. the lesser curvature is concave and forms the right border of the stomach. It
provides attachment to the lesser omentum. The angular incisura (notch) is
the sharp indentation approximately two thirds of the distance along the
 lesser curvature that approximates the junction of the body and pyloric part
of the stomach.
6. the greater curvature is convex and forms the left border of the stomach. it
provides attachment to the greater omentum, the gastrosplenic ligament and
the gastrophrenic ligament.
Skeletotopia.
- cardiac lies back to the cartilage of the 7 th rib, 2,5cm left from the left
sternal’s side, opposite the Th11 thoracic vertebra.
- The fundus of the stomach reaches the lower side of the 5 th rib at the
medioclavicl line.
- Pyloric of the empty stomach’s situated at the midline or right from it,
opposite the cartilage of the 8th rib and corresponds the L1 lumbal vertebra.
Peritoneal relations and ligaments.
The stomach is lined by peritoneum on both its surface. At the lesser curvature
the layers of peritoneum lining the anterior it posterior surface meet and
become continuous with the lesser omentum. Along the greater curvature the
two layers meet to form the great omentum. Near the cardiac end of the greater
curvature the layers meet to form the gastrosplenic ligament. Near the cardiac
end the peritoneum on the posterior surface is reflected on to the diaphragm as
the gastrophrenic ligament. Cranial to this ligament a small part of the posterior
surface of the stomach is in direct contact with the diaphragm. This is the bare
area of the stomach.
Visceral relations.
The anterior surface relations of the stomach are:
- the spleen
- the left lobe of the liver
- the anterior abdominal wall
- the diaphragm
The posterior surface of the stomach which we call the stomach bed is related to
the following structures:
- the pancreas
- the transverse mesocolon
- splenic flexure of the colon
- the diaphragm
- the left kidney
- the left suprarenal gland
- the splenic artery
All these structures are repeated from the stomach by the cavity of the lesser
sac.
The blood supply.
1. There are two arteries in the anterior layer of the peritoneum along the lesser

curvature: the right and left gastric arteries.

The left gastric artery is a branch of the celiac trunk.
The right gastric artery arises fro the common hepatic artery. The branches of
these two arteries are distributed both to the front and back of the stomach.
2. The blood vessels, running along the great curvature are the left and right
gastroepiploic arteries.
The left gastroepiploic artery is a branch of the splenic artery.
The right gastroepiploic artery running to the left is a branch of the gastro-
duodenal artery from the hepatic artery. Both these arteries running along the
great curvature send branches upwards on to both surfaces of the stomach and
downwards into the great omentum.
3. On the posterior surface of the fundus of the stomach there are 4-5 short

gastric arteries, which are branches of the splenic artery.

Veins of the same name with these arteries drain into the superior mesenteric
and splenic veins, and then to the portal system.
Lymphatic drainage.
Direction of the drains lymphatic vessels of the stomach, which are situated in
the subserouse layer, corresponds to the direction of the blood vessels of the
stomach.
There are four lymphatic zones of the first stage in the stomach. They are:
- nodes of the lesser curvature. These nodes also draine the abdominal part
part of the esophagus. Lymph from these nodes drains into the coeliac nodes.
- Nodes of the great curvature. This chain is still better macked along the
lower border of the pylorus , forming the pyloric group of lymph nodes.
- Nodes draining into the pancreaticoplenic nodes laying along the splenic
artery to reach the coeliac nodes.
- Lymph drains in differentions into pyloric, hepatic and right gastric nodes,
and passes from all these nodes to the celiac nodes.
The lymph from all areas of the stomach reaches the celiac artery. There is a
second stage of the lymph drain of the stomach. From here lymph passes
through the intestinal lymph trunk to reach the cistern chili.
Nerve supply.
The nerve supply of the stomach is carried out by the parasympathetic and
sympathetic nerve.
The sympathetic nerves arise from the Th6-Th9 segments of the spinal cord via
the greater splanchnic nerves and the celiac and hepatic plexuses and is
distributed as plexuses the gastric and gastroomental arteries. They run along
the arteries, arising from the celiac artery trunk and supplying the stomach.
They are:
- vasomotor;
- motor to the pyloric sphincter but inhibitory to the rest of the gastric
musculature;
- the chief pathway for pain sensations from the stomach.
The parasympathetic nerves, arising from the vagi nerves, branching on the
anterior and posterior walls of the stomach: left vagus on the anterior wall and
right vagus on the posterior wall.
They form the plexus with the branches of the sympathetic trunk in the
subserouse layer. There are a several ganglions here.
Parasympathetic nerves are motor and secretomotor to the stomach. the most
sensual to reflex influence zones of the stomach are piloris antrum and the great
part of the lesser curvature.